Neuroma Excision

A neuroma, sometimes called a “nerve tumor”, is believed to be the body’s response to some type or trauma, irritation or excess pressure that causes the nerve to be compressed, stretched or otherwise damaged. Although they can appear in other parts of the body, neuromas are most often found on the bottom of the foot and are referred to as Morton’s neuroma. 

Generally benign, Morton’s neuroma is not technically a tumor: it is a thickening of the tissue that surrounds one of the nerves leading to the toes, usually the intermetatarsal plantar nerve. Once it has developed, there will typically be pain felt in the ball of the foot, caused by a thick mass of tissue that has formed around the nerve.

If you have developed a neuroma on the bottom of your foot, you are likely to know it. The symptoms are hard to mistake for anything else, because the sensation of shooting pain, referred to as metatarsalgia, has been compared to that of walking on a rock or marble that is connected to an electrical charge. 

Who Was Morton?

Who was Morton and why is his name associated with shooting pain in the foot? 

Thomas G. Morton was a hospital administrator and surgeon during the Civil War. Military footwear during that period was often ill-fitting and too tight, and that led to the foot being held in a compressed position for extremely long periods of time and the development of neuromas.

Besides the likelihood of having treated a number of cases of neuroma during the war, Dr. Morton was known as a researcher, as well as playing a significant role in the founding of well-known and prominent hospitals, such as the Philadelphia Orthopaedic Hospital and the Infirmary for Nervous Diseases. During this time, he studied the symptoms associated with metatarsalgia and went on to publish his results. This led to his name being attached to the condition that produces those symptoms. 

Symptoms of Morton’s Neuroma

A Morton’s neuroma cannot be detected visually. It does not appear as a lump or growth. There is rarely any pain or discomfort while sitting or lying down; only when taking a step and applying pressure to the ball of the foot. The most common symptoms associated with Morton’s neuroma include:

  • Sharp, but sometimes intermittent,  pain when putting pressure on the ball of foot
  • A tingling or stinging sensation that extends to one or two toes that nerve supplies
  • Numbness extending into the supplied toes
  • A radiating sensation, like an electric shock that can extend out into the toes
  • Feeling like something hard, like a rock or marble, is inside the shoe and pressing painfully on the ball of the foot

Women develop Morton’s neuroma far more often than men do, up to ten times more often, in fact. This implies that high heels or other shoes with narrow toes are a major contributor to the development of neuromas. Some of the other factors believed responsible for creating this condition are activities, especially sports, that result in repeated pressure being put on the ball of the foot and physical conditions, like bunions, hammer toes, and fallen or high arches, that throw off the natural striking pattern of the foot.  

Treatment: Conservative and Surgical

Neuromas can generally be treated conservatively. Suggestions will usually include some combination of:

  • reducing or eliminating activities that put pressure on the ball of the foot
  • pain and inflammation management with icing and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen 
  • using special pads or custom orthotics to lessen the pressure on the nerve
  • wear more appropriate shoes that do not overly compress the foot, especially avoiding high heels and narrow toes
  • injection therapy, including cortisone, may be suggested

Neuroma Excision

Once a neuroma has formed, it will not go away on its own, and we have yet to find a way to shrink it. The conservative treatment options listed above are sufficient for most people. For others that is not the case. It’s impossible to walk for any distance without placing weight on the ball of the foot, and if doing so causes significant and ongoing pain, your orthopedist may recommend surgery to remove the portion of the nerve that contains the neuroma. This procedure is called a neuroma excision. 

The procedure is typically done under regional anesthesia, and the patient will be able to go home the same day. 

A small longitudinal incision is made, usually on the top of the foot. The enlarged portion of the nerve is removed. The incision will then be closed, and the foot will be bandaged. Following surgery, a post-operative shoe will need to be worn until the wound fully healed, which is usually about two weeks. The foot should be kept elevated during this time. Around week 3, the patient should be able to gradually begin a return to normal activities.